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Kim, Kim, Kim, Shim, Lee, and Ryu: A Case-Controlled Study of Cognitive Behavioral Therapy for Patients with Schizophrenia Having Violence-Related Crime
Original Article

Korean J Schizophr Res 2014;17(2):80-85.

Published online: 20 June 2014

DOI: https://doi.org/10.16946/kjsr.2014.17.2.80

A Case-Controlled Study of Cognitive Behavioral Therapy for Patients with Schizophrenia Having Violence-Related Crime

Won Young Kim, MD1, , Sun Bum Kim, MA2, Myeong Jae Kim, MD1, Geumsook Shim, MD, PhD1, Jin Young Lee, MD1, Mi Kyung Ryu, MD, PhD1

1Department of Psychiatry, National Institute of Forensic Psychiatry, Ministry of Justice, Gongju, Korea

2Department of Social Service, National Institute of Forensic Psychiatry, Ministry of Justice, Gongju, Korea

Address for correspondence: Won Young Kim, Department of Psychiatry, National Institute of Forensic Psychiatry, Ministry of Justice, 253 Banpochogyo-gil, Banpo-myeon, Gongju 314-716, Korea Tel: 041-840-5459, Fax: 041-840-5498 E-mail: goodmedi@naver.com

Received 5 August 2014       Revised 15 September 2014       Accepted 22 September 2014

Copyright © 2014 Korean Society for Schizophrenia Research

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

Despite remarkable development of pharmacotherapy for schizophrenia, some patients continuously have had violence problems. The violence of psychotic patients is recently becoming the focus of the attention. The aim of this study is to investigate the influence of Cognitive Behavioral Therapy (CBT) on patients with schizophrenia having violence related history.

Methods

15 Patients with schizophrenia spectrum disorder of crime history were treated with individual CBT for 12 sessions, and assessed with 4 scales (Korean version of Aggression Questionnaire, Korean version of the Barratt Impulsiveness Scale-11-Revised, Beck Cognitive Insight Scale and Positive and Negative Syndrome Scale) to evaluate anger, impulse, insight and clinical symptoms respectively at baseline and post treatment. The comparison group consisted of 15 patients with schizophrenia spectrum disorder of crime history. They were also assessed with the same scales during the same period.

Results

: Although impulsivity is not changed significantly after treatment, but there was significant improvement in clinical symptom, insight and aggression, especially self-reflectiveness and anger respectively.

Conclusion

: CBT can be one of the good therapeutic tools for patients with schizophrenia having violence problems in that it reduces aggression and enhances insight of patients with schizophrenia spectrum disorder.

Keywords: Schizophrenia, Cognitive behavioral therapy, Violence, Crime history.

References

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Table 1.
Type of Crimes: the treated and the non-treated group
  CBT (n=15) TAU (n=14)
Patricide or Matricide (%) 4 (26.7) 3 (21.4)
Attempted murder (%) 3 (20.0) 4 (28.6)
Arson (%) 3 (20.0) 2 (14.3)
Robbery or Assault (%) 5 (33.3) 5 (35.7)

CBT: Cognitive-behavioral therapy, TAU: Treatment as usual

Table 2.
Basic characteristics of the treated and non-treated group
Characteristic CBT (n=15) TAU (n=14) p
Sex (%) Age years SD 11 (73.0) 37.4 8.15 10 (71.4) 36.2 6.85 .913 .676
Age (years)(SD) 37.4 (8.15) 36.2 (6.85) .676
Education (years)(SD) 13.9 (2.55) 13 (2.79) .229
Age of onset (years)(SD) 25.2 (6.42) 26.4 (6.13) .603
Duration of illness (years)(SD) 12.3 (9.42) 9 (4.55) .131
Duration of admission (months)(SD) 15 (6.49) 16.2 (8.69) .736

CBT: Cognitive-behavioral therapy, TAU: Treatment as usual

Table 3.
Scores of baseline and post treatment for CBT and TAU group
    CBT (n=15) TAU (n=14) t p
M SD M SD
K-BIS-11-R Baseline 64.40 14.52 63.21 13.22 .229 .820
End point 62.07 16.80 61.85 10.26 .040 .968
BCIS Baseline 04.13 03.27 05.21 03.40 –.873 .391
End point 09.93 02.66 05.71 02.49 4.40 .000
K-AQ Baseline 65.73 19.26 64.57 13.67 .186 .854
End point 49.33 08.64 63.50 15.75 –2.18 .039
PANSS Baseline 65.60 13.17 73.00 17.38 –1.29 .205
End point 59.80 13.82 71.71 16.54 –2.11 .044

CBT: Cognitive-behavioral therapy, TAU: Treatment as usual, K-BIS-11-R: Korean version of the Barratt Impulsiveness Scale-11-Revised, BCIS: Beck Cognitive Insight Scale, K-AQ: the Aggression Questionnaire (Korean Version), PANSS: Positive and Negative Syndrome Scale

Table 4.
Subcategories of the Aggression Questionnaire (Korean Version)(K-AQ) of the Cognitive-behavioral therapy group
    M SD t p
Physical Baseline 19.26 6.49 3.914 .002
End point 16.20 5.10    
Verbal Baseline 13.26 3.83 4.002 .001
End point 10.27 2.31    
Anger Baseline 13.86 4.74 5.664 .000
End point 07.40 1.99    
Hostility Baseline 19.40 6.41 3.674 .003
End point 14.86 3.50    
Table 5.
Subcategories of the Beck Cognitive Insight Scale (BCIS) of the Cognitive-behavioral therapy group
    M SD t p
Self-reflectiveness Baseline 19.67 3.02 –6.48 .000
End point 24.13 3.99
Self-certainty Baseline 15.53 3.46 –2.96 .010
End point 14.33 3.58
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